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Introduction

We swallow approximately 1200 times daily, largely subconsciously. While we take the fundamental function for granted, disordered swallowing can be a devastating condition, with substantial morbidity for those affected.

Dysphagia is difficulty in swallowing. It is a common problem affecting up to 22% of patients in the general practice setting.1 It is usually associated with a sensation of hold-up of the swallowed bolus and is sometimes accompanied by pain.

Its origin is considered as either oropharyngeal or oesophageal. Oropharyngeal dysphagia is usually related to neuromuscular dysfunction and is commonly caused by stroke. Oesophageal dysphagia is usually due to motor disorders, such as achalasia or diffuse oesophageal spasm, and to peptic oesophageal strictures often secondary to reflux. In this type of dysphagia there is a sensation of a hold-up, which may be experienced in either the cervical or retrosternal region.1 Causes are usually classified as functional, mechanical and neurological (see Table 48.1).

Dysphagia must not be confused with globus sensation, which is the sensation of the constant ‘lump in the throat’ although there is no actual difficulty swallowing food. If dysphagia is progressive or prolonged then urgent attention is necessary.

There are only a few common causes of dysphagia and these are usually readily diagnosed on the history and two or three investigations. A careful history is very important, including a drug history and psychosocial factors.